Eliminating Fighting and Head Hits from Hockey: Opportunities and Barriers.

Removing fighting from ice hockey is an essential concussion prevention strategy that will improve the safety of the game at all levels.

The Effect of Body Checking Policy Changes on Concussion Incidence in Canadian Male Youth Ice Hockey Players: A Critically Appraised Topic.

Clinical Scenario: Current studies have identified body checking as the most common cause of sports-related concussion in ice hockey across all divisions and levels. As a result, many hockey organizations, particularly in youth sports, have implemented rules making body checking to the head, face, and/or neck illegal. Such a rule, in Canada, makes age 13 the first age in which individuals can engage in body checking. Despite these changes, effectiveness of their implementation on the incidence of concussion in Canadian male youth ice hockey players remains unclear. Clinical Question: What is the effect of body checking policy changes on concussion incidence in male youth ice hockey players? Summary of Key Findings: Of the 3 included studies, 2 studies reported a decrease in the incidence of concussion once a body checking policy change was implemented. The third study showed an increase; however, it is important to note that this may be due, in part, to increased awareness leading to better reporting of injuries. Clinical Bottom Line: Current evidence supports a relationship between body checking policy implementation and decreased concussion incidence; however, more research is needed to understand the long-term implications of policy change and the effects in other leagues. In addition, further data are needed to differentiate between increased concussion incidence resulting from concussion education efforts that may improve disclosure and increased concussion incidence as a direct result of policy changes. Strength of Recommendation: Grade B evidence exists that policy changes regarding body checking decrease concussion incidence in male youth ice hockey players.

Effect of Penalty Minute Rule Change on Injuries and Game Disqualification Penalties in High School Ice Hockey.

BACKGROUND: Recent efforts have focused on eliminating dangerous hits in ice hockey. Fair play rule changes have successfully reduced injury risk but have not been widely implemented. PURPOSE: To determine the effect of a penalty infraction minutes (PIM) rule change in high school boys' ice hockey on injuries and game disqualification penalties. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Injury data were collected from 2 Rhode Island hospital systems and game/penalty data through the Rhode Island Hockey Coaches Association website. Participants included high school boys' hockey varsity players aged 13 to 19 years presenting to 5 emergency departments for hockey injuries during 6 seasons (December 2012-April 2018). Rule change for the 2015-2016 season implemented varying suspensions for players accumulating ≥50 PIM and ≥70 PIM during regular season and playoffs. Injuries were classified as body checking or non-body checking related, and injury rates pre- versus post-rule change were compared via the Cochran-Mantel-Haenszel chi-square test with the odds ratio (OR) to measure risk reduction. RESULTS: During the study period, 1762 boys' high school varsity hockey games were played. Of 134 game-related injuries, 82 (61.2%) were attributable to body checking. The PIM rule change was associated with a significant reduction in all injuries (OR, 0.55; 95% CI, 0.35-0.86; P = .008), concussion/closed head injury (OR, 0.44; 95% CI, 0.23-0.85; P = .012), and combined subgroups of concussion/closed head injury and upper body injury (OR, 0.50; 95% CI, 0.31-0.80; P = .003). Game disqualification penalties per season were not significantly reduced following the rule change, occurring in 5.2% of games before the rule change and 4.4% of games after (OR, 0.84; 95% CI, 0.54-1.31; P = .440). CONCLUSION: Implementation of a statewide PIM restriction rule change effectively reduced the mean number of game-related injuries per season among high school boys' hockey varsity players.

Development of the Sports Organization Concussion Risk Assessment Tool (SOCRAT).

OBJECTIVE: In this paper, we describe the development of a novel tool-the Sports Organization Concussion Risk Assessment Tool (SOCRAT)-to assist sport organizations in assessing the overall risk of concussion at a team level by identifying key risk factors. METHODS: We first conducted a literature review to identify risk factors of concussion using ice hockey as a model. We then developed an algorithm by combining the severity and the probability of occurrence of concussions of the identified risk factors by adapting a risk assessment tool commonly used in engineering applications. RESULTS: The following risk factors for ice hockey were identified: age, history of previous concussions, previous body checking experience, allowance of body checking, type of helmet worn and the game or practice environment. These risk factors were incorporated into the algorithm, resulting in an individual risk priority number (RPN) for each risk factor and an overall RPN that provides an estimate of the risk in the given circumstances. CONCLUSION: The SOCRAT can be used to analyse how different risk factors contribute to the overall risk of concussion. The tool may be tailored to organizations to provide: (1) an RPN for each risk factor and (2) an overall RPN that takes into account all the risk factors. Further work is needed to validate the tool based on real data.

The risk of injury associated with body checking among Pee Wee ice hockey players: an evaluation of Hockey Canada's national body checking policy change.

BACKGROUND: In 2013, Hockey Canada introduced an evidence-informed policy change delaying the earliest age of introduction to body checking in ice hockey until Bantam (ages 13-14) nationwide. OBJECTIVE: To determine if the risk of injury, including concussions, changes for Pee Wee (11-12 years) ice hockey players in the season following a national policy change disallowing body checking. METHODS: In a historical cohort study, Pee Wee players were recruited from teams in all divisions of play in 2011-2012 prior to the rule change and in 2013-2014 following the change. Baseline information, injury and exposure data for both cohorts were collected using validated injury surveillance. RESULTS: Pee Wee players were recruited from 59 teams in Calgary, Alberta (n=883) in 2011-2012 and from 73 teams in 2013-2014 (n=618). There were 163 game-related injuries (incidence rate (IR)=4.37/1000 game-hours) and 104 concussions (IR=2.79/1000 game-hours) in Alberta prior to the rule change, and 48 injuries (IR=2.16/1000 game-hours) and 25 concussions (IR=1.12/1000 game-hours) after the rule change. Based on multivariable Poisson regression with exposure hours as an offset, the adjusted incidence rate ratio associated with the national policy change disallowing body checking was 0.50 for all game-related injuries (95% CI 0.33 to 0.75) and 0.36 for concussion specifically (95% CI 0.22 to 0.58). CONCLUSIONS: Introduction of the 2013 national body checking policy change disallowing body checking in Pee Wee resulted in a 50% relative reduction in injury rate and a 64% reduction in concussion rate in 11-year-old and 12-year-old hockey players in Alberta.

Ice Hockey Summit II: zero tolerance for head hits and fighting.

OBJECTIVE: To present currently known basic science and on-ice influences of sport-related concussion (SRC) in hockey, building on the Ice Hockey Summit I action plan (2011) to reduce SRC. METHODS: The prior summit proceedings included an action plan intended to reduce SRC. As such, the proceedings from Summit I served as a point of departure, for the science and discussion held during Summit II (Mayo Clinic, Rochester MN, October 2013). Summit II focused on (1) Basic Science of Concussions in Ice Hockey: Taking Science Forward; (2) Acute and Chronic Concussion Care: Making a Difference; (3) Preventing Concussions via Behavior, Rules, Education and Measuring Effectiveness; (4) Updates in Equipment: their Relationship to Industry Standards; and (5) Policies and Plans at State, National and Federal Levels to reduce SRC. Action strategies derived from the presentations and discussion described in these sectors were subsequently voted on for purposes of prioritization. The following proceedings include knowledge and research shared by invited faculty, many of whom are health care providers and clinical investigators. RESULTS: The Summit II evidence-based action plan emphasizes the rapidly evolving scientific content of hockey SRC. It includes the most highly prioritized strategies voted on for implementation to decrease concussion. CONCLUSIONS: The highest priority action items identified from the Summit includes the following: (1) eliminate head hits from all levels of ice hockey, (2) change body-checking policies, and (3) eliminate fighting in all amateur and professional hockey.

Ice Hockey Summit II: zero tolerance for head hits and fighting.

This study aimed to present currently known basic science and on-ice influences of sport-related concussion (SRC) in hockey, building upon the Ice Hockey Summit I action plan (2011) to reduce SRC. The prior summit proceedings included an action plan intended to reduce SRC. As such, the proceedings from Summit I served as a point of departure for the science and discussion held during Summit II (Mayo Clinic, Rochester, MN, October 2013). Summit II focused on (1) Basic Science of Concussions in Ice Hockey: Taking Science Forward, (2) Acute and Chronic Concussion Care: Making a Difference, (3) Preventing Concussions via Behavior, Rules, Education, and Measuring Effectiveness, (4) Updates in Equipment: Their Relationship to Industry Standards, and (5) Policies and Plans at State, National, and Federal Levels To Reduce SRC. Action strategies derived from the presentations and discussion described in these sectors were voted on subsequently for purposes of prioritization. The following proceedings include the knowledge and research shared by invited faculty, many of whom are health care providers and clinical investigators. The Summit II evidence-based action plan emphasizes the rapidly evolving scientific content of hockey SRC. It includes the most highly prioritized strategies voted on for implementation to decrease concussion. The highest-priority action items identified from the Summit include the following: (1) eliminate head hits from all levels of ice hockey, (2) change body checking policies, and (3) eliminate fighting in all amateur and professional hockey.

The incidence of behaviours associated with body checking among youth ice hockey players.

OBJECTIVES: To determine if a difference exists between the incidence and intensity of the physical contacts of Pee Wee (aged 11-12 years) ice hockey players according to whether the players participate in a league in which body checking is permitted (Calgary, Canada) compared to a league in which body checking is not permitted (Québec City, Canada). DESIGN: Cohort study conducted in Québec City and Calgary during the 2007-2008 Pee Wee ice hockey season. METHODS: Ten games were randomly selected for each city (n=20) and analysed. Games were videotaped and subsequently analysed with a validated observation system allowing quantification of the intensity of the various physical contacts. Incidence rate ratios (RR) based on multivariate Poisson regression were used to compare the physical contacts between provinces. All analyses were controlling for game period, score difference, and zone on the playing surface. RESULTS: A total of 2418 physical contacts with the trunk and 757 other physical contacts were observed. Very light intensity trunk physical contacts were more frequent in Québec City (adjusted incidence RR [ARR]: 0.68; 95% CI: 0.48-0.97). Very high intensity trunk physical contacts were more frequent in Calgary (ARR: 12.72; 95% CI: 4.48-36.14). Hooking (ARR: 0.89; 95% CI: 0.84-0.95) and slashing (ARR: 0.91; 95% CI: 0.85-0.97) were more frequent in Québec City. CONCLUSIONS: Results suggest that players' behaviours are different in leagues where body checking is permitted compared to leagues where it is not permitted. Policy allowing body checking in Pee Wee ice hockey increases the frequency and intensity of physical contacts.

Global positioning system data analysis: velocity ranges and a new definition of sprinting for field sport athletes.

Global positioning system (GPS) technology has improved the speed, accuracy, and ease of time-motion analyses of field sport athletes. The large volume of numerical data generated by GPS technology is usually summarized by reporting the distance traveled and time spent in various locomotor categories (e.g., walking, jogging, and running). There are a variety of definitions used in the literature to represent these categories, which makes it nearly impossible to compare findings among studies. The purpose of this work was to propose standard definitions (velocity ranges) that were determined by an objective analysis of time-motion data. In addition, we discuss the limitations of the existing definition of a sprint and present a new definition of sprinting for field sport athletes. Twenty-five GPS data files collected from 5 different sports (men's and women's field hockey, men's and women's soccer, and Australian Rules Football) were analyzed to identify the average velocity distribution. A curve fitting process was then used to determine the optimal placement of 4 Gaussian curves representing the typical locomotor categories. Based on the findings of these analyses, we make recommendations about sport-specific velocity ranges to be used in future time-motion studies of field sport athletes. We also suggest that a sprint be defined as any movement that reaches or exceeds the sprint threshold velocity for at least 1 second and any movement with an acceleration that occurs within the highest 5% of accelerations found in the corresponding velocity range. From a practical perspective, these analyses provide conditioning coaches with information on the high-intensity sprinting demands of field sport athletes, while also providing a novel method of capturing maximal effort, short-duration sprints.

Proceedings from the ice hockey summit on concussion: a call to action.

OBJECTIVE: The objective of this proceeding is to integrate the concussion in sport literature and sport science research on safety in ice hockey to develop an action plan to reduce the risk, incidence,severity, and consequences of concussion in ice hockey. methods: A rationale paper outlining a collaborative action plan to address concussions in hockey was posted for review two months prior to the Ice Hockey Summit: Action on Concussion. Focused presentations devoted specifically to concussion in ice hockey were presented during the Summit and break out sessions were used to develop strategies to reduce concussion in the sport. This proceedings and a detailed scientific review (a matrix of solutions) were written to disseminate the evidence based information and resulting concussion reduction strategies. The manuscripts were reviewed by the authors, advisors and contributors to ensure that the opinions and recommendations reflect the current level of knowledge on concussion in hockey. RESULTS: Six components of a potential solution were articulated in the Rationale paper and became the topics for breakout groups that followed the professional, scientific lectures. Topics that formed the core of the action plan were: metrics and databases; recognizing,managing, and return to play; hockey equipment and ice arenas;prevention and education; rules and regulations; and expedient communication of the outcomes. The attendees in breakout sessions identified action items for each section. The most highly ranked action items were brought to a vote in the open assembly, using an Audience Response System (ARS). The strategic planning process was conducted to assess: Where are we at?; Where must we get to?; and What strategies are necessary to make progress on the prioritized action items? CONCLUSIONS: Three prioritized action items for each component of the solution and the percentage of the votes received are listed in the body of this proceeding.

Proceedings from the Ice Hockey Summit on Concussion: a call to action.

OBJECTIVE: : The objective of this proceeding was to integrate the concussion in sport literature and sport science research on safety in ice hockey to develop an action plan to reduce the risk, incidence, severity, and consequences of concussion in ice hockey. DESIGN: : A rationale paper outlining a collaborative action plan to address concussions in hockey was posted for review 2 mos before the "Ice Hockey Summit: Action on Concussion." Focused presentations devoted specifically to concussion in ice hockey were presented during the summit, and breakout sessions were used to develop strategies to reduce concussion in the sport. The proceedings and a detailed scientific review (a matrix of solutions) were written to disseminate the evidence-based information and resulting concussion reduction strategies. The manuscripts were reviewed by the authors, advisors, and contributors to ensure that the opinions and recommendations reflect the current level of knowledge on concussion in hockey. RESULTS: : Six components of a potential solution were articulated in the "Rationale" paper and became the topics for breakout groups that followed the professional scientific lectures. Topics that formed the core of the action plan were metrics and databases; recognizing, managing, and return to play; hockey equipment and ice arenas; prevention and education; rules and regulations; and expedient communication of the outcomes. The attendees in the breakout sessions identified the action items for each section. The most highly ranked action items were brought to a vote in the open assembly, using an Audience Response System. The strategic planning process was conducted to assess the following: "Where are we at?" "Where must we get to?" "What strategies are necessary to make progress on the prioritized action items?" CONCLUSIONS: : Three prioritized action items for each component of the solution and the percentage of the votes received are listed in the body of this proceeding.

Proceedings from the Ice Hockey Summit on concussion: a call to action.

OBJECTIVE: The objective of this proceeding is to integrate the concussion in sport literature and sport science research on safety in ice hockey to develop an action plan to reduce the risk, incidence, severity, and consequences of concussion in ice hockey. METHODS: A rationale paper outlining a collaborative action plan to address concussions in hockey was posted for review 2 months before the Ice Hockey Summit: Action on Concussion. Focused presentations devoted specifically to concussion in ice hockey were presented during the Summit, and breakout sessions were used to develop strategies to reduce concussion in the sport. This proceedings and a detailed scientific review (a matrix of solutions) were written to disseminate the evidence-based information and resulting concussion reduction strategies. The manuscripts were reviewed by the authors, advisers, and contributors to ensure that the opinions and recommendations reflect the current level of knowledge on concussion in hockey. RESULTS: Six components of a potential solution were articulated in the Rationale paper and became the topics for breakout groups that followed the professional, scientific lectures. Topics that formed the core of the action plan were metrics and databases; recognizing, managing, and returning to play; hockey equipment and ice arenas; prevention and education; rules and regulations; and expedient communication of the outcomes. The attendees in breakout sessions identified action items for each section. The most highly ranked action items were brought to a vote in the open assembly by using an Audience Response System. The strategic planning process was conducted to assess the following: Where are we at? Where must we get to? What strategies are necessary to make progress on the prioritized action items? CONCLUSIONS: Three prioritized action items for each component of the solution and the percentage of the votes received are listed in the body of this proceeding.

Proceedings from the Ice Hockey Summit on concussion: a call to action.

The objective of this proceedings is to integrate the concussion in sport literature and sport science research on safety in ice hockey to develop an action plan to reduce the risk, incidence, severity, and consequences of concussion in ice hockey. A rationale paper outlining a collaborative action plan to address concussions in hockey was posted for review two months prior to the Ice Hockey Summit: Action on Concussion. Focused presentations devoted specifically to concussion in ice hockey were presented during the Summit and breakout sessions were used to develop strategies to reduce concussion in the sport. This proceedings and a detailed scientific review (a matrix of solutions) were written to disseminate the evidence-based information and resulting concussion reduction strategies. The manuscripts were reviewed by the authors, advisors and contributors to ensure that the opinions and recommendations reflect the current level of knowledge on concussion in hockey. Six components of a potential solution were articulated in the Rationale paper and became the topics for breakout groups that followed the professional, scientific lectures. Topics that formed the core of the action plan were: metrics and databases; recognizing, managing and return to play; hockey equipment and ice arenas; prevention and education; rules and regulations; and expedient communication of the outcomes. The attendees in breakout sessions identified action items for each section. The most highly ranked action items were brought to a vote in the open assembly, using an Audience Response System (ARS). The strategic planning process was conducted to assess: Where are we at?; Where must we get to?; and What strategies are necessary to make progress on the prioritized action items? Three prioritized action items for each component of the solution and the percentage of the votes received are listed in the body of this proceedings.

Complex training in ice hockey: the effects of a heavy resisted sprint on subsequent ice-hockey sprint performance.

The aim of the study was to investigate the acute effect of a heavy resisted sprint when used as a preload exercise to enhance subsequent 25-m on-ice sprint performance. Eleven competitive ice-hockey players (mean ± SD: Age = 22.09 ± 3.05 years; Body Mass = 83.47 ± 11.7 kg; Height = 1.794 ± 0.060 m) from the English National League participated in a same-subject repeated-measures design, involving 2 experimental conditions. During condition 1, participants performed a 10-second heavy resisted sprint on ice. Condition 2 was a control, where participants rested. An electronically timed 25-m sprint on ice was performed before and 4 minutes after each condition. The results indicated no significant difference (p = 0.176) between pre (3.940 + 0.258 seconds) and post (3.954 + 0.261 seconds) sprint times in the control condition. The intervention condition, however, demonstrated a significant 2.6% decrease in times (p = 0.02) between pre (3.950 + 0.251 seconds) and post (3.859 + 0.288 seconds) test sprints. There was also a significant change (p = 0.002) when compared to the times of the control condition. These findings appear to suggest that the intensity and duration of a single resisted sprint in this study are sufficient to induce an acute (after 4 minutes of rest) improvement in 25-m sprint performance on ice. For those athletes wishing to improve skating speed, heavy resisted sprints on ice may provide a biomechanically suitable exercise for inducing potentiation before speed training drills.

Multidimensional performance characteristics and standard of performance in talented youth field hockey players: a longitudinal study.

To identify performance characteristics that could help predict future elite field hockey players, we measured the anthropometric, physiological, technical, tactical, and psychological characteristics of 30 elite and 35 sub-elite youth players at the end of three consecutive seasons. The mean age of the players at the end of the first season was 14.2 years (s = 1.1). Repeated-measures analyses of covariance, with standard of performance and measurement occasion as factors and age as a covariate, showed that the elite players fared better than the sub-elite players on technical and tactical variables. Female elite youth players also scored better on interval endurance capacity, motivation, and confidence. Future elite players appear to have excellent tactical skills by the age of 14. They also have good specific technical skills and develop these together with interval endurance capacity better than sub-elite youth players in the subsequent 2 years. To verify our conclusions, we will be tracking these players into adulthood.

Effect of bodychecking on injury rates among minor ice hockey players.

BACKGROUND: In 2002, Hockey Canada changed the age classifications for minor ice hockey. Previously, 10- and 11-year-old children played at the Atom level (no bodychecking), and 12- and 13-year-old children played at the Peewee level (bodychecking allowed). After the policy change, 11-year-old players were placed in the Peewee division with 12-year-old players; the Atom division included 9- and 10-year-old players. The objective of this study was to examine the effect that the policy change had on injuries to 11-year-old players and compare this information with injury trends among 10- and 12-year-old players. METHODS: The study location was the Capital Health region, which serves the greater Edmonton area in Alberta. Capital Health maintains a database of all emergency department visits in the region. A search of the database identified 10-, 11- and 12-year-old players admitted to 7 emergency departments with hockey-related injuries during the 2 years before and the 2 years after the policy change. We also conducted a chart review for the 11-year-old players, extracting detailed information on the nature and circumstances of their injuries for the same period. RESULTS: The rate of injuries sustained by 11-year-old children playing at the Peewee level (with bodychecking) increased significantly compared with the rate among 11-year-old players at the Atom level (rate ratio [RR] 1.9, 95% confidence interval [CI] 1.4-2.4). The rate of severe injuries was more than 2 times greater among 11-year-old Peewee players than among 11-year-old Atom players (RR 2.4, 95% CI 1.6-3.6). Injury rates among the 10-year-old players (bodychecking never allowed) and the 12-year-old players (bodychecking always allowed) changed little over the study period. INTERPRETATION: The introduction of bodychecking to 11-year-old players was associated with a large increase in injury rates. From a public health perspective, the age at which bodychecking is introduced in minor hockey should be raised.